TMJ Disorders: How Chiropractic Care Provides Relief | Podcast Ep. 381

Foreign welcome to the evidence based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode we're talking all about the temporomandibular joint, TMA joint which kind of sounds like ATM machine, automatic teller machine machine. TMJ joint is what we're gonna be talking about on today's episode. New study that came out, an open access case report and it just came out this month in 2023 on Cureus and that is spelled C U R E U S. We'll drop a link down in the show notes if you want to check it out yourself. I thought it was a good opportunity just to explore the TMJ that we rarely talk about on the show. And also it's an area where I just don't. I'm not the best clinician on taking care of those issues but. But that doesn't mean it's not important. That doesn't mean it's not showing up. And I'd love to learn more. Hopefully you would too. I'll also give a huge shout out to Dr. Alex Vidan, one of my long term friends who teaches about taking care of the TMJ all over the world. So if you want to step up your clinical skills, highly recommend every time he's speaking about it to check it out because he has just really, really great information, really solid information. Today's episode will be a broad overview not of technique, but more about what the research says. And it is titled the PA Temporomandibular disorder treated with Chiropractic Therapy. And again, we'll drop that link down in the show notes. Now before we get started, I wanna take a few moments to talk about Patient pilot by the Smart Chiropractor. Patient pilot by the Smart Chiropractor is the number one reactivation system in chiropractic. Our average member generating 26 reactivations each and every month via automated email campaigns. If you would like to step up your reactivations, I'm gonna encourage you to do a demo. It's easy. Head over 15, we'll ask you a bunch of questions, we'll dive into what you are currently doing and see if it's a good fit. You can do that@thesmartchiropractor.com again that is at the smartchiropractor.com but as I said at the top on today's episode we're focusing on the tmj. Temporomandibular disorders. They constitute a array of different symptoms that affect the temporomandibular joint and the surrounding musculoskeletal tissues. So historically, these things have been known interchangeably, right? Temporomandibular disorder was known as TMJ dysfunction syndrome. Functional TMJ changes, Myofascial pain dysfunction syndrome, Temporomandibular pain dysfunction syndrome. All of those things kind of just lump into the same thing. I am sure there's somebody listening that knows the nitty gritty differences between all of them. And there probably are differences, but. But in general, they're all kind of fall under the same bucket. So easy to kind of just know that as you look at the literature and as we talk through it today, we'll use those terms pretty interchangeably. Now, how big of a deal is this? It's probably a bigger deal than it seems. So TMD occurs in 4% or more of the adult population in the United States. So every hundred, which is wild to think about, every hundred people, that four of them have a TMJ issue is a really, really big deal. And I think it's why us as chiropractors, we see this. It's not the number one thing, right? You're gonna see more low back, more headache, more neck pain. However, like shoulders, like knees, like hips and ankles. This is one of those things that does show up, not obscurely, but relatively consistently in our practices and is predominantly characterized by pain syndromes that include myofascial pain, myalgia and arthralgia. So how does this all begin? Well, it's not really well understood as far as the etiology is concerned, but it is thought to contribute or be correlated or caused by a variety of different challenges. Some biological, some environmental, some social, some emotional, and even some cognitive factors so important to keep in mind, like skeletal pain. This is multifactorial by nature. And there is an emotional, a cognitive, a social component, and potentially even environmental. So aside from just the biomechanics alone, and that's really important when you're having conversations with your patients, asking pointed questions, inspiring people towards better health. These are really, really key components, beyond just being the technician of delivering the adjustment, the that matter. And they really matter, in my opinion. So what are some other comorbidities associated with the TMJ issue? Chronic headaches, pretty obvious there. Fibromyalgia, autoimmune diseases, sleep apnea, which is interesting, and psychiatric illness. So these are real big factors and real big comorbidities. Chronic headaches is an easy one, but some of these others I probably wouldn't have guessed. Sleep apnea, for instance, Psychiatric illness So make sure you're doing a deep dive on some of the history here, because again, if the contributing factors are really, really deep and really, really wide, beyond just the biomechanics alone, it might take some time. And it might take more than one or two treatments to get somebody really feeling better. Because you have to build a relationship with them. You have to inspire them to better health. You have to change a little bit of their outlook. Not that we are psychologists or psychiatrists, but we're doctors, we're teachers, we're educators, and we're those partners in health. We need to show up as that and show up not knowing that asking the right questions can ultimately lead to far better outcomes. Now, it also has been shown that depression and anxiety increase TMJ issues. They increase the risk, I guess I should say, of TMJ issues and myofascial pain. So, you know, again, these maybe aren't the first things. If somebody comes in with a TMJ issue, you're like, well, you know, do I ask about, you know, depression and anxiety in this case? It seems as though we should be asking some questions around that because you really, really want to get to the heart of the cause. And it might be a little obscure, it might be a little opaque. You might not be able to say just because somebody's depressed, they have a TMJ issue. It's not that linear, but it's important to understand that. So as you guide treatment and care, you can do it in the most meaningful way possible. Now here's the really, really good news. Non invasive treatment options relieve pain in up to 90% of the people struggling with TMJ issues. So 9 out of 10 people, your practice is basically where they should be. They should be getting non invasive rehabilitative treatment, which is what we do. It is what you do as a chiropractor. Now, non steroidal anti inflammatories, NSAIDs like naproxen, they have been commonly prescribed. Additionally, we see muscle reluctance and antidepressants used to treat some of the pain. And lastly, there are surgical interventions when rehabilitative techniques are not really getting it done. But 90% of the time, you should be able to really, really help people, if not more than that. But you have to be able to ask the right questions. And the other thing is you think about these alternatives and it's just like, ah, it just kills me when it's like the alternative is a medication. Like if you have a biomechanical issue that's influenced by anxiety and depression, you're taking like an nsaid. Ugh. I just. How, how is that gonna help the situation? It's just not most of the time. So be aware. Also expectations with patients is why I'm saying that, that they're not cutting bait too soon if it's gonna take like just too many chiropractors out there. In my opinion, stop treatment too soon and patients might be feeling a little better, but when it comes back two weeks later, they think the care didn't work, when really they just didn't do enough of it. And that's a really important distinction to take to heart, because if the patient two weeks later comes back and they don't think chiropractic worked, they don't come back again. I say this, practicing in orthopedic practices for a number of years, people would come in, I'd be like, how'd you do with the chiropractor? You saw a chiropractor three years ago? Oh, I did. Fantastic. But then it came back, so I knew it didn't work. That is like super, super common. And those people, you don't know it because they don't come back into your practice, but I can assure you they're going other places. So don't shortchange the care that you're delivering or the time it will take. Pain is the last thing to come and the first thing to go. And have you addressed some of these other challenges, concerns, issues, in order to get somebody over the hump long term, that is really, really the key component of it, because if not, think about what they're doing. Medications that are gonna be ineffective, have risks and probably not work, or surgical intervention specifically on the tmj. That should almost never happen, except ridiculously rare occasions. So the onus is on us to ensure that we are having those conversations as much in a proactive manner as possible. So chiropractic therapy has been shown to be super, super promising. There was a Meta analysis of 20 RCTs, randomized control trials where chiropractic therapy was shown to significantly improve measures of pain. Maximum mouth opening, as they say, MMO and disability of the TMJ patients. So spinal manipulation and manual therapy were the most effective chiropractic techniques to treat the the TMJ. So in this study they had a 30, 39 year old female, six months of worsening TMJ issues. And the pain was an ache. It exacerbated by chewing, yawning, talking, pretty important things. And the patient was reported to have frequent locking in the Open mouth position. Pain was rated at an average of a 6 out of 10. So this is a really, really big deal for this patient. Now, upon examination, the patient's jaw had limited range of motion. There's muscle tension in the neck and shoulders, and interestingly, her CER range of motion was only like 15 degrees compared to a normal of 45 degrees plus. And tenderness to palpation was reported pretty much everywhere in the head and neck. So based upon this, the patient was diagnosed with a tmd, a temporomandibular disorder, as well as myofascial pain syndrome. Probably no surprises as far as that's concerned. They use chiropractic to take care of the TMD in the patient. They utilize an array of different techniques. Spinal adjustments, soft tissue therapy, exercise, rehab, all good and really, really good ideas. Therapy was twice, or, excuse me, three times a week for two weeks. So six visits. They adjusted C1, 2, 56 and C7, T1 to alleviate muscle tension and joint dysfunction. They used some scraping therapy for reduction of soft tissue tightness and then exercise to improve the range of motion in the neck and jaw. Now, at the end of that two weeks, which is a pretty short period of time, this patient reported a 70% improvement in the symptoms they were experiencing, which is a really, really, really big deal. So the combination of care really was effective in this case. It's probably what's gonna be most effective in your practice as well. They get into some discussion points later on saying, manual mandibular therapy, wow, that's a tongue twister. Of the tmj is regarded as the most effective, effective treatment for alleviating pain and disability. And that's a really important component of this. Now they do cervical spine manipulation. High velocity, low amplitude thrust were better than some of the mobilization techniques. And in a randomized control trial, investigating strategies for taking care of tmj, upper cervical spinal manipulation combined with dry needling was also shown to be more effective at reducing pain and improving the mouth opening compared to things like splint therapy. I have no idea why you use splint therapy. That's a whole nother story. Diclofenac, duh. And TMJ mobilization at a three month follow up. So another key component or layer to this is understanding that the cervical spine may play a significant role in an array of these cases. So if you see a TMJ case, do not just look there. Don't become so myopic. We've been talking about this more and more. Be sure to always address the adjacent body region or joint. In this case it is the cervical spine. And definitely there's so many of the structures are intertwined and there's so much compensation that can occur if not causation or correlation for that matter. A lot of Cs. It is important to check out the cervical spine anytime you're dealing with somebody with a TMJ type issue. So again, if you want to check more about technique, there's a bunch of great opportunity to learn about tmj, usually at state association meetings. Alex Vinando is a great, great job at it, but this was a great study for me just to say, hey, what's going on with the tmj? It's something I never felt super, super comfortable taking care of. But I think the clinical pearls that I would take out of this study are a couple. Number one is this is a real deal type thing with 4 or 5% of people dealing with it. It's something that is important that we know how to take care of. Number two is the alternatives are horrible. So it is even more important that we know exactly how to take care of this. And best news of all with that is 90% of people plus will get great results with the care that we deliver. And don't be afraid to take a multimodal approach. Whether it's dry needling and adjustments, whether it is scraping tools, soft tissue work, whether it is exercise rehab, whether it is a combination of all, of course, with the adjustment at the center of it all, I think it's a great way to approach cases like this and really, really be able to get awesome results. So before we wrap up, I will say a few words about Zing it. Zing it still has a great, great offer going on right now. They're an awesome tech solution. They can get you 23 Google reviews in a month. Patient show rates 94% plus that only scratches the surface. And if you visit zingit.com offer I'll drop that link down below. Schedule a demo@zingit.com offer they'll hook you up with $100 DoorDash gift card just for the demo. So head over there, do a demo. This is probably gonna be something can help your practice and you're gonna get a gift card out of it. Why the heck wouldn't you do that? Head over to zingit.com offer I'll drop it down below. And before we wrap up, if you're on my email list, you saw some emails go out about this, but if you did not click over now is the chance to do so and that is for a power step orthotic and what I use is what my dad uses. These are designed by a podiatrist over 30 years ago. I love them. They support the show. I hope you support them. And they want to hook you up with a free sample pair. No reason not to do that. Pro powerstep.com sample Pro powerstep.com sample if you use the code EBC for evidence based carburetor they will hook you up with a free sample pair. As a chiropractor listen to this show. I just also want to say thank you so much for listening to this show. If you've not left us a rating or review, we would greatly, greatly appreciate it. That helps more and more docs find out about this show. If you have any questions, any concerns or you think we should highlight a specific study that you geek out on, hit me up. Jeff the evidence basedchiropractor.com Otherwise I hope you have a fantastic week in practice and I will talk to you soon.

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